Iraqi Journal of Hematology

Abstract:
BACKGROUND: Hodgkin’s lymphoma (HL) exhibits a cure rate of 90% in patients diagnosed at an early stage and a cure rate ranging from 70% to 90% in patients diagnosed at an advanced stage. In the case of patients with relapsed/refractory HL (r/rHL), it is recommended to provide salvage chemotherapy initially, followed by autologous stem cell transplantation (ASCT). The ideal conditioning regimen for the transplantation process is still being investigated.
OBJECTIVES: For individuals with r/rHL, high‑dose chemotherapy combined with ASCT (HD‑ASCT) is thought to be the most effective method of treatment. The purpose of this research was to evaluate the effectiveness and safety of the busulfan, cyclophosphamide, and etoposide (BuCyE) preparation regimen in r/rHL patients.
MATERIALS AND METHODS: Retrospective analysis was conducted on the data of 67 lymphoma patients older than 18 years who had HD‑ASCT with the BuCyE conditioning regimen between September 2014 and November 2021 (86 months). The research consisted of 34 r/r HL patients among them. A parenteral regimen of 0.8 mg/kg of busulfan every 6 h from day −7 to day −5, 50 mg/kg of cyclophosphamide on days −3 and −2, and 400 mg/m2 of etoposide on days −5 and −4 comprised the patient preparation regimen before ASCT. All data were collected from inpatient files and the Inonu University Turgut Ozal Medical Center Hospital Information System.
RESULTS: The median age of the patients was 43 years, and 67.6% were males. The most common type of HL was nodular sclerosis, which was followed by mixed cellularity. The median time for platelet and neutrophil engraftment was 14 and 11 days, respectively. 5.0 × 106/kg was the median transplanted dose of CD34+ cells (2.1–13.55). Liver toxicity was observed in 6 (17.6%) patients. Eight patients suffered from pulmonary side effects. The median number of previous chemotherapies was 2 (2–4). In all lymphoma patients, the complete response rate was 61.8% (n = 21), whereas the disease progression rate was 32.3% (n = 11). Transplantation‑related mortality on the 100th day was 8.8% (n = 3). Three‑year overall survival was 57.17%.
CONCLUSION: When the literature was reviewed, the studies with the BuCyE preparation regimen in patients with r/rHL were limited. This conditioning regimen was found to have fewer side effects and a lower cost. It can be preferable when compared to carmustine (BCNU), etoposide, cytarabine (ARA-C), and melphalan (known as BEAM) in r/rHL.

Abstract:
BACKGROUND: Lymphoblastic lymphomas (LBL) are a rare, aggressive type of non‑Hodgkin lymphomas and constitute 2% of all lymphomas. It is classified as T‑lymphoblastic lymphoma (T‑LBL) and B lymphoblastic lymphoma (B‑LBL) and resembles acute lymphoblastic leukemia (ALL), with no or limited bone‑marrow involvement. LBL rarely present as soft‑tissue swellings. Soft‑tissue involvement is more common in B‑LBL than in T‑LBL. They occur predominantly in adolescents and young adults and have a prognosis similar to ALL.
OBJECTIVE: The aim was to study the clinical characteristics, treatment response, and survival of patients with lymphoblastic lymphoma presenting with soft‑tissue swelling.
SETTINGS AND DESIGN: This was a retrospective study of eight adolescent and adult patients with lymphoblastic lymphoma presenting with soft‑tissue swelling conducted in the Department of Medical Oncology at a tertiary cancer center in India.
STATISTICAL ANALYSIS: The baseline patient characteristics, treatment details, and response assessment were analyzed using descriptive statistics. Overall survival (OS) and progression‑free survival were obtained by the Kaplan–Meier method, using the SPSS version. 11.
MATERIALS AND METHODS: We present the clinical features, imaging, diagnosis, treatment, and outcome of eight cases of lymphoblastic lymphoma presenting with soft‑tissue swellings. Patients above 14 years of age treated over 12 years were included in the study.
RESULTS: There were five males and three females. The median age at diagnosis was 24 years. Common presenting complaints were swelling, pain, and paraparesis. The sites of involvement were the epidural mass, thigh, calf, breast, and anterior chest wall. The diagnosis was confirmed by immunohistochemistry. Seven patients were diagnosed with B‑LBL and one with T‑LBL. They were treated with intensive chemotherapy (six patients with Berlin–Frankfurt–Munster protocol and two with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Three patients received consolidation radiotherapy and one received palliative radiotherapy. Seven patients attained remission after induction chemotherapy and four of them are currently alive at a median follow‑up of 48 months. The 2‑year OS was 71.4%.
CONCLUSION: Even though rare, lymphoblastic lymphoma should be considered a differential diagnosis in patients presenting with soft‑tissue swelling and should be managed with systemic chemotherapy similar to ALL.

BACKGROUND: Chronic myeloid leukemia (CML) is a type of myeloproliferative neoplasm characterized by the excessive accumulation of malignant myeloid cells in the bone marrow and peripheral blood. This condition is primarily triggered by a specific chromosomal translocation known as t(9;22) (q34.13;q11.23), which leads to the formation of the BCR‑ABL fusion gene. The treatment landscape for CML has undergone significant changes with the approval of tyrosine kinase inhibitors (TKIs) targeting the BCR‑ABL1 kinase activity. One such inhibitor is bosutinib, which has been available for several years to treat patients with chronic, accelerated, and blast‑phase CML who have shown resistance or intolerance to previous therapies.
OBJECTIVES: The aim of this study was to assess efficacy and safety of Bosutinib as a 2nd line therapy in CML patients, in addition to effect of adherence to treatment on patients response.
PATIENTS AND METHODS: Eighty‑five patients with CML were enrolled in a prospective cohort study from October 2021 to October 2022 at Hematology Center in Medical City Complex – Baghdad. All patients failed to at least one TKI, and all of them started escalated dose of bosutinib. The patients were followed-up by assessing molecular and cytogenetic response at 3 and 6 months and monitored carefully for adverse events (AEs) which were graded by common terminology IX criteria for AEs version 5. Adherence to bosutinib was also monitored by a specific adherence scale to optimize the response rate to treatment.
RESULTS: The mean age of patients was 47.3 ± 14.9 (range: 18–77), with male:female ratio 1.4:1. Status of CML patients showed that 89.4% were in the chronic phase, 5.8% in accelerated phase, and 4.7% in blast phase. Regarding the number of previous TKIs before bosutinib, 72.9% of patients failed to prior one TKI (imatinib). At 6 months (72.3%), patients achieve optimal response according to European Leukemia Net criteria 2013. Gastrointestinal symptoms and dermatological manifestations were the most common nonhematological AEs of bosutinib. According to 9‑item Morisky Medication Adherence Scale, 42% of patients were adherent to medication which showed a significant association with a higher number of optimal response (P = 0.0001).
CONCLUSION: Bosutinib is effective with a high and promising response as a subsequent line treatment in CML patients, and it is generally safe and associated with mild‑to‑moderate tolerable and manageable AEs. Adherence to the drug plays a significant role in optimal response to bosutinib.

Abstract:
BACKGROUND: Acute myeloid leukemia (AML) is a diversified disorder, characterized by clonal proliferation of myeloid precursors in peripheral blood (PB) and bone marrow (BM). Growth differentiation factor 15 (GDF15) is a member of transforming growth factor‑β superfamily that has an important role in cancer prognosis and pathophysiology and it can induce apoptosis and inhibit growth and invasion of tumor.
OBJECTIVES: The aim of this study was to estimate the GDF15 plasma levels in patients with de novo AML and their association with patients’ survival.
MATERIALS AND METHODS: A cross‑section samples from 60 adult patients who were newly diagnosed with de novo AML from September 2022 to September 2023 were included. Other 30 healthy adult individuals were involved as controls. The measurement of plasma GDF15 level was established by the ELISA technique using the human GDF15 ELISA kit.
RESULTS: Plasma (GDF15) was higher in AML patients, and it was associated with inferior overall survival (OS). Plasma (GDF15) level shows positive correlation with age, hemoglobin level, and insignificant correlation with the BM and PB blast percentages, total white blood cell count, sex, and platelets.
CONCLUSIONS: Plasma GDF15 levels in AML patients were high at the diagnosis and were associated with inferior OS.

Abstract:
BACKGROUND: Leukemia is characterized by an uncontrolled expansion or proliferation of hematopoietic cells that are unable to develop appropriately into mature blood cells. Tissue inhibitor of metalloproteinases (TIMP) is glycoprotein with 28 Da Molecular weight. It has proteolytic and proliferative activity show pleiotropic effects in the bone marrow regulates cell responsible for survival and growth also healthy hematopoietic progenitor cells and involve in cancer progression.
OBJECTIVES: The aim of this study was to measure TIMP in Iraqi acute myeloid leukemia patients as well as the correlation between tissue inhibitor of matrix metalloproteinase‑1 and blast cells.
PATIENTS MATERIALS AND METHODS: The study involved 50 patients from Iraqi National Hematology Center/Al‑Mustansiriyah University and Baghdad Teaching Hospital with acute myeloid leukemia and 50 control participants who were physically similar. The patients’ ages ranged from 20 to 70 years. Tissue inhibitor of matrix metalloproteinase concentration in plasma was measured using a sandwich enzyme immunoassay approach that is quantitative.
RESULTS: The present study demonstrates a statistically significant increase in the level of tissue inhibitor of matrix metalloproteinase‑1 patients with acute myeloid leukemia. The level of TIMP‑1 in serum AML patients was 443.7 ± 0.3 pg/mL while in healthy control serum was 149.5 ± 0.088 pg/mL. The current result showed a positive significant correlation between TIMP‑1 level and blast Cells percentage (r = 0.495; P = 0.031), while the correlation between leukocytes number and platelets number was insignificant (r = 0.388; P = 0.078, r = −0.444; P = 0.155).
CONCLUSION: TIMP‑1 levels increased in the CML patient compared with healthy control also there was a significant correlation between TIMP-1 and Blast cell level while no correlation between level of TIMP-1 and number of leukocytes and platelets. The level of TIMP in patients untreated and undergoing chemotherapy does not change.

Abstract:
BACKGROUND: Arsenic trioxide (ATO) regimen is now the standard of care for acute promyelocytic leukemia (APL). The complete remission and possible cure are reported to be 50%–80% of APL patients. Prolongation of the QT interval has been consistently observed in clinical trials with ATO, which is known to have a direct effect on cardiac repolarization with the recommendations for management include electrocardiogram (ECG) monitoring, discontinuation of drugs that prolong the QT interval, and careful repletion of serum potassium and magnesium.
OBJECTIVES: To study the incidence and clinical consequences of QT prolongation in a sample of Iraqi APL patients treated with ATO.
PATIENTS AND METHODS: A prospective, cross‑sectional study was conducted on 24 adult patients with newly diagnosed APL at Baghdad Teaching Hospital. ECG was performed at baseline and twice weekly till the end of induction treatment course. Corrected QT interval was calculated based on Bazett and Fridericia formulas (QTc interval of more than 500 ms is considered dangerous): Serum potassium, calcium, and magnesium levels were also measured simultaneously.
RESULTS: The mean QT at baseline was 424 ± 18 ms and 402 ± 15 ms by Bazett and Fridericia, respectively, and at the end of induction, the mean QT was 436 ± 20 ms and 418 ± 20 ms by Bazett and Fridericia, respectively. The rate of developing prolonged QT was 62.5% by Bazet, in which 15 patients developed prolonged QT (at any time point). The comparison between prolonged and dangerous QT groups by Bazet showed significant difference, in which QT‑related complications were associated with dangerous QT (>500 ms) prolongation significantly, while Fridrica method did not label these patients as having dangerous QT prolongation. The change in QT started as early as 1 week after treatment, the comparison between baseline QT and QT at week 1 showed that there was significant increase in QT. The electrolytes analysis and comparison with baseline results for potassium, magnesium, and calcium showed that there were no significant differences over time for tested electrolytes.
CONCLUSION: Bazett formula is useful to monitor Iraqi patients with APL who are treated with ATO for the detection of dangerous prolongation of QT.

Abstract:
BACKGROUND: Thalassemia is the most common human monogenic disease in the world, associated with several consequences, including recurrent infections, many studies have demonstrated a high prevalence of infection among individuals with thalassemia accounting for about 10% of cases.
OBJECTIVE: This study aimed to detect the effect of serum iron imbalance on the prevalence of infection in thalassemia patients.
MATERIALS AND METHODS: This research was conducted in the Thalassemia Teaching Department at Al Karama Hospital, between March and October 2023. The case–control study was conducted by comparing 60 people with thalassemia with 60 other people who were not thalassemic but suffering from fever and similar symptoms. Through examining urine, sputum, blood, and skin swab samples, samples with a positive result for the bacteria were identified, their sensitivity to antibiotics was examined, and these results were compared with the control group. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus, three types of the most common bacteria were chosen for testing due to the limited resources.
RESULTS: Control groups of 20 males and 30 females with a mean age of 20 ± 4.5 years compared to 60 nonthalassemia febrile patients classified into 34 males and 26 females with the same age range as control groups. It was discovered that the majority of thalassemia patients are infected with E. coli bacteria. It also depends in its infection rate on an imbalance in the level of iron in the blood, whether it is increased, as in thalassemia, or decreased in cases of iron deficiency anemia that E. coli bacteria is the type that most infects thalassemia patients.
CONCLUSION: Common species of bacteria responsible for infection in thalassemia patients represented by E. coli, K. pneumoniae, and Staphylococcus aureus associated with serum iron level changes highlighting the need for additional research into the impact of iron imbalance on infections. The study found that imipenem and meropenem had a profound effect on the vast majority of bacterial species involved in thalassemia.

Abstract:
BACKGROUND: The most prevalent type of leukemia in adults is called chronic lymphocytic leukemia (CLL). is a lymphoproliferative condition is defined by the mature clone’s expansion in blood, secondary lymphoid tissues, spleen and the bone marrow. CCL3 is a cytokine that is involved in development, repair, and the acute inflammatory state. CCL3, therefore, should become useful for risk assessment in patients with CLL.
OBJECTIVES: The aims of the study were to estimate the level of plasma CCL3 in newly diagnosed patients with CLL matched to healthy controls and correlate it with hematological parameters and clinical parameters and prognostic markers such as CD38 and LAIR‑1.
PATIENTS, MATERIALS AND METHODS: This study was cross‑sectional in nature. Patient group included 55 patients with newly established diagnosis of CLL proven by morphology and immunophenotyping and control group included sex and age matched of 30 healthy individuals. The plasma CCL3 levels were measured using an enzyme‑linked immunosorbent assay. Microsoft Office Excel 2019 and SPSS version 26 were used for the statistical analysis. The mean and standard deviation of normally distributed numerical values whereas the terms “median” and “range” were used to describe numerical values that are not regularly distributed. P <0.05 was used to determine the degree of significance.
RESULTS: There were statistically significant relationships between CCL3 of patient (median level about 766.42 ng/ml) and control (median level about 453.35 ng/ml) groups (P < 0.001). There was a strong correlation between CCL3 and white blood cell, hemoglobin, and absolute lymphocyte count (P = 0.013, P < 0.001, and P = 0.011, respectively). There was a strong relationship between CCL3 expression with Binet stage and with hepatomegaly (P < 0.001 and P = 0.020, respectively), but no significant relation between CCL3 expression and CD38 and LAIR‑1.
CONCLUSIONS: Patients with CLL had high levels of CCL3, which increased with advancing Binet stages. Therefore, our research clarified the useful and simplicity of measurement of CCL3 plasma levels for follow‑up in CLL patients and risk assessment.

Abstract:
BACKGROUND: Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy described by a translocation between chromosomes 9 and 22. There are many factors genetic or nongenetic effect on disease progression such as growth factors and transcription factors act as oncogenes or tumor suppressor genes.
OBJECTIVES: The purpose of this research was to investigate the role of hypoxia‑inducible factor (HIF1A) gene expression with CML, as well as the role of monocyte chemoattractant protein‑1 (MCP‑1) as a predictive biomarker on disease progression.
MATERIALS AND METHODS: The current study consists of three groups: first group includes 50 newly diagnosed CML patients (females 22 and males 28), second group consists of 50 CML patients treated with tyrosine kinase inhibitor (TKI) with a complete molecular response (p210 BCR‑ABL transcript levels ≤0.1% IS) (female 25 and male 25), and third group included another 50 apparently healthy volunteers (female 20 and male 30). The patients were admitted from the National Center of Hematology/Mustansiriyah University. All patients are diagnosed according to a complete blood count (CBC), a bone marrow examination, and a BCR‑ABL gene test.
RESULTS: Reverse transcription‑quantitative polymerase chain reaction was applied to assess the expression levels of the HIF-1A gene and serum level of MCP1 by enzyme‑linked immunosorbent assay. The results displayed downregulated of the HIF1A gene messenger RNA in CML patients in comparison to the controls group, as well as no statistically significant link was discovered when the fold of expression was correlated with the age and gender of CML patients.
CONCLUSION: HIF1‑alpha gene has an important role in pathological pathways such as angiogenesis. According to this study, HIF1‑alpha gene is not an appropriate prognostic biomarker for detecting the risk of CML as well as MCP1 is thought to be a predictor of CML progression.

Abstract:
BACKGROUND: Acute myeloid leukemia (AML) is a clonal malignant condition of immature hematopoietic cells, characterized by clonal proliferation of abnormal cells (blasts) in the marrow leading to impairment of the normal blood cell production giving rise to failure of the bone marrow. Soluble interleukin‑2 (IL‑2) receptor alpha chain is a protein that is involved in the assembly of the high‑affinity IL‑2 receptor, and it has a critical role in controlling immune system homeostasis. The overexpression of sIL‑2RA was investigated in many hematopoietic malignancies, and it was correlated with poor outcome.
OJECTIVES: The aim of this study was to assess the sIL‑2RA level as a prognostic factor and assess its impact on survival and if it can be used as a targeted treatment for a better outcome.
MATERIALS AND METHODS: Sixty newly diagnosed adults with AML before starting therapy were included in the study, and they were followed up for 6 months to document survival status. Thirty healthy adults were taken as a control group. Using an enzyme-linked immunosorbent assay, the plasma sIL‑2RA level was measured. Statistical analysis was done using Microsoft Excel 2019 and version 26 SPSS statistical software. P <0.05 was considered statistically significant.
RESULTS: A considerable difference in the plasma sIL‑2RA level between AML patients and controls also was more elevated in patients who died after 6‑month follow‑up. According to the blast percentage, total white blood cell count, and M0‑M2 subgroups, the sIL‑2RA level correlated positively. Irrelevant association was found regarding the patients’ age, the count of platelet, and the hemoglobin.
CONCLUSIONS: Plasma sIL‑2RA level is higher in AML patients than the control group at the time of diagnosis. Patients with a high level of plasma sIL‑2RA have an inferior (overall survival) and poor outcome. SIL‑2RA level is higher in M0‑M2 subgroups than other subtypes. There is a significant association between sIL‑2RA level and the absolute count of leukemic blasts.

Abstract:
BACKGROUND: Hairy cell leukemia (HCL) is a rare chronic B‑cell lymphoproliferative disorder. Modern therapy with purine analogs and immunotherapy can provide long‑term remission, but the risk of recurrence remains about 40%–50%. The aim of this study was to evaluate the outcome of patients with HCL who received treatment in Nanakali Hospital.
PATIENTS AND METHODS: A retrospective cross‑sectional study was carried out on 50 patients of HCL diagnosed from 2004 to 2022 in Nanakali Hospital in Erbil City, Kurdistan Region, Iraq. Demographics, clinical presentation, treatment data, complications, response, recurrence, and survival data were collected from medical records. The results were presented with descriptive statistics. Variables were compared by Chi‑square analysis.
RESULTS: The mean age was 52.64 ± 12.37 years, and 84% were male. The most common presenting symptoms were splenomegaly (18%) and fatigue (14%). The majority (69.6%) received cladribine; the response rate was 73.9%, with a complete remission (67.4%). 47.8% had recurrent disease. The most common adverse effects were febrile neutropenia (58.7%) and Grade III and IV hematologic toxicity (41.3%). The results were significantly associated with ANC pretreatment (P = 0.019), comorbidity (P = 0.001), and treatment response (P = 0.004). Cladribine–rituximab combination resulted in complete remission (100%). Ten‑year overall survival was 70%.
CONCLUSIONS: The results were broadly consistent with literature reports, demonstrating the efficacy and safety of cladribine with/without rituximab as first‑line therapy for HCL but with a 30% mortality of concern. Further studies should identify modifiable factors that affect poor prognosis in subgroups to guide improvements in risk management of HCL.

Abstract:
BACKGROUND: Blood donation is an essential global need far outweighs the available supply, rendering it a scarce and valuable resource. Within India, blood transfusion services hold significant importance and constitute a crucial aspect of the national health‑care framework. Voluntary Non‑Remunerated Blood Donation (VNRBD) is deemed the safest among the various ways of donating blood. The student population of educational institutions across the country, particularly those who are young and physically fit, represents one of the most promising sources of blood donations. The aim of the study was to evaluate the knowledge, attitudes, and donation practices of medical college students and motivate them to embrace voluntary blood donation as a regular habit.
MATERIAL AND METHODS: The Department of Allied Health Science at Dr MGR Educational and Research Institute in Chennai, Tamil Nadu, India, conducted a questionnaire survey from March 2023 to October 2023. Two thousand and two hundred forty students were invited to participate, with 2331 ultimately willing to partake. The gathered data underwent analysis using the SPSS Statistics software, version 20, with a significance level fixed at a P = 5%.
RESULTS: The study included 2331 participants, comprising 840 males (36%) and 1491 females (64%). The age range of the participants was between 17 and 25 years, with a mean age of 18.9 ± 1.3 years. Out of 2331 participants, the majority (66.7%) showed sufficient knowledge with 9 or more correct answers, while the rest (33.2%) showed below‑average knowledge.
CONCLUSION: The Tamil Nadu Health Professions Colleges possess the potential to make a noteworthy impact on the promotion of blood donation. According to a recent survey, students express a keen interest in donating blood if a camp is organized on the campus. By organizing awareness campaigns and conducting informative sessions, the colleges can inspire and motivate more students to donate blood, thereby playing a vital role in saving lives.

Abstract:
BACKGROUND: The current study was initiated to evaluate the comparability of fetomaternal hemorrhage (FMH) measurement using flow cytometry (FCM) and Kleihauer–Betke test (KBT) and also to evaluate the validity of the current anti‑D immunoglobulin doses for the prevention of hemolytic disease of the newborn in Duhok/Iraq.
MATERIALS AND METHODS: The current study included 101 pregnant women with Rh(D)‑negative blood group who had Rh (D)‑positive husbands. Their blood was tested for blood groping, FMH by FCM and KBT, and indirect Coombs test, 1 h following sensitizing events and 72 h after giving anti‑D. Furthermore, blood from newborns was examined for blood group and direct Coombs test.
RESULTS: The main sensitizing event was parturition (62.4%) followed by cesarean section (32.7%). The indirect Coombs was positive in 32 cases while the direct Coombs test was positive in 19 cases. In 63.4% of cases, the ABO blood groups were incompatible between mothers and their babies. When FMH was checked by KBT method, it was found that 16 (15.8%) participants had FMH ranging 1.2–51 mL (median 4.35 mL), while FMH was positive in 27 (26.7%) participants by FCM method ranging 1.2–54.4 ml (median 9.5 mL). About 4–5 patients had FMH (measured by KBT and FCM, respectively) of >12 mL and only 1% had a volume of >30 mL. The difference between KBT and FCM for FMH measurement was statistically significant with P < 0.001 when assessed by paired t‑test and has a highly significant positive correlation with each other. The correlation of FMH was statistically significant with maternal gravidity, number of anti‑D received before (moderate positive correlation), gestational age, and newborn hemoglobin (negative correlation). However, the correlation was not significant between FMH and the following factors: maternal parity, maternal hematological parameters, and ABO compatibility of mother and their babies with P > 0.05.
CONCLUSION: Inadequate doses of anti‑D had been given previously that resulted in sensitization in at least one‑quarter of the cases, and this necessitated proper measurement of FMH in all Rh (D) mothers following sensitizing events.

Abstract:
INTRODUCTION: Many studies have reported the association of SARS‑CoV‑2 with benign and malignant hemopathies. Data from African series are scarce. This work was conducted in sub‑Saharan Africa and aimed to study the clinical, biological, and evolutionary features of hemopathies associated with this infection.
MATERIALS AND METHODS: It was a retrospective, cross‑sectional study carried out over 32 months including 86 patients with benign or malignant hemopathies who underwent coronavirus disease‑2019 (COVID‑19) confirmed by the real‑time reverse transcriptase‑polymerase chain reaction or presenting with atypical clinical signs associated with highly suggestive computed tomography (CT) scan signs.
RESULTS: The mean age of patients was 48.3 ± 18.7 years with a sex ratio of 0.75. The main benign hemopathies were sickle cell trait (SCT) (n = 51), sickle cell disease SS (n = 8), and sickle cell disease SC (n = 1), while malignant hemopathies were represented by multiple myeloma (n = 5), non‑Hodgkin lymphoma (n = 5), and chronic lymphocytic leukemia (n = 4). The clinical symptoms mainly featured anemic syndrome (16.3%) and a vaso‑occlusive crisis was found in 9.3% of homozygous sickle‑cell patients. The infection was moderate in 48% of cases and severe in 19.7%. The severe forms were commonly found in patients with malignant hemopathies (47.6%) and the benign forms were noted in benign hemopathies (38.4%). Full blood count outlined anemia in 32.5% and lymphopenia in 23.2% of cases. On imaging, the CT scan reported severe lesions in 41.3% of cases. The outcome resulted in full recovery in 76.7% of cases, and mortality occurred in 23.3%. In univariate analysis, death was mainly noted in patients with lymphoid hemopathies (15%). Comorbidities (P < 0.0001), lymphoid hemopathies (P < 0.0001), and the severity of COVID‑19 (P < 0.0001) had a positive impact on death occurrence in univariate analysis.
CONCLUSION: The association between SARS‑CoV‑2 and hemopathy is not uncommon and is dominated by benign hemopathies. Malignant hemopathies are at‑risk underlying conditions justifying a hospital follow‑up of mild forms, allowing better survival. Particular attention must be paid to SCT with comorbidities and those with sickle cell disease of disease.

Abstract:
BACKGROUND: Radiotherapy is important for the treatment of cancer but it is not without side effects on the human body like lethal effects on blood cells. This study aimed to estimate the effect of radiotherapy on blood parameters in cancer patients.
PATIENTS AND METHODS: One hundred and two patients from Zhianawa Hospital in Sulaymaniyah Province, Iraq, were included in this study from July 2022 to October 2022. The blood samples were collected for blood analysis and the information of participants was taken through a detailed questionnaire.
RESULTS: Out of the 102 patients, 61 (59.8%) females and 41 (40.2%) males, the median age was 50.1 years ± 17.02 years. Forty‑nine (48%) of studied patients were in Stage 4 and the most common cancer was breast cancer accounting for 43 (42.2%). We found a statistically significant (P < 0.05) reduction in total white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin, and platelet counts, but regarding neutrophils, the reduction was statistically not significant (P = 0.343). Doses of radiotherapy and more advanced stages of cancer affect the degree of the reduction of blood counts and it can be seen in different ages. The cell drop was significantly lower in younger patients, aged <60 years as related to the curative intent in those age groups.
CONCLUSION: The results suggest that radiotherapy has a potential effect on circulating WBCs, RBC counts, and platelets, but not neutrophils and it is related to the stage of cancer and age of the patients

Abstract:
BACKGROUND: Acute myeloid leukemia (AML) is a complex, heterogeneous disease driven by acquired somatic mutations. The presence of specific mutations advances stratification, treatment, and prognosis. Linear accumulation of mutations over time is a crucial factor in cancer development, particularly among elderly patients. Our recent study on gene rearrangement in AML revealed a significant association between age and adverse risk cases.
AIM: The aim of this study was to examine the distribution of age, molecular characteristics, risk stratification, and treatment response based on age among patients with de novo AML in Iraq.
PATIENTS AND METHODS: A prospective cohort study enrolled 115 Iraqi adult patients diagnosed with de novo AML using morphology and flow cytometry from December 2020 to May 2022. The Leukemia Q‑Fusion Screening Kit, employing multiplex reverse transcription–real‑time quantitative polymerase chain reaction with 30 gene rearrangements, was employed for the identification of gene rearrangement. The patients received care and follow‑up at the Hematology Unit of Baghdad Teaching Hospital in Medical City. Ethical approval from the College of Medicine’s Ethical Committee at the University of Baghdad was secured before commencing the research, ensuring adherence to ethical standards throughout the study.
RESULTS: The age distribution exhibited a bimodal pattern, with a mean of 45.1 ± 17.5 years, ranging from 18 to 84 years, and a median of 46 years. A total of 39.1% of patients were diagnosed with AML before the age of 35 years, while 43% were diagnosed after the age of 51 years. AML patients with RARA mutations, RUNX1::RUNX1T1 alterations, and NPM1 mutations were predominantly observed in younger individuals, as well as those diagnosed with AML defined by differentiation. Conversely, KMT2A rearrangements were more prevalent among older age groups, with a statistically significant difference in the distribution of AML classifications according to the World Health Organization (WHO) by age categories (P = 0.001). The risk stratification based on age and response assessment showed a notable higher risk profile observed among elderly patients that was associated with adverse risk and poorer response and mortality (P < 0.05). The prediction of treatment response accuracy rate was improved by adding age to the WHO classification and ELN 2022 risk stratification (73.5%–87.9%).
CONCLUSION: Age significantly influences AML prognosis and treatment response. Incorporating age into risk stratification improves accuracy. Tailored approaches considering age are vital for optimizing AML management and outcomes.

Abstract:
BACKGROUND: Human cytomegalovirus (HCMV) infection is ubiquitous and successfully reactivated in patients with immune dysfunction as in patient with multiple myeloma (MM), causing a wide range of life‑threatening diseases. Early detection of HCMV and significant advances in MM management has amended patient outcomes and prolonged survival rates.
OBJECTIVES: The aim of the study was to estimate the frequency of active HCMV in MM patients.
MATERIALS AND METHODS: This is a case–control study involved 50 MM patients attending Hematology Center, Baghdad Teaching Hospital; 25 of them were newly diagnosed and 25 on treatment compared to 50 of apparently healthy control. HCMV‑viral load was measured using a real‑time polymerase chain reaction (RT‑PCR).
RESULTS: Active HCMV was detected in 8 patients out of 50 (16%); 6/25 (24%) in newly diagnosed and 2/25 (8%) on treatment and had autologous bone marrow transplant with mean ± standard deviation of 910 × 1010 ± 210 × 1010, and 32,000 × 1010 ± 1500 × 1010 IU/mL, respectively. HCMV viremia is equally detected in both remission and relapsed cases.
CONCLUSION: RT‑PCR detected a significant number of MM patients infected by cytomegalovirus compared to healthy individuals. Further studies are needed to verify if this finding has a relation to etiology or disease progression.

Abstract:
BACKGROUND: Chronic lymphocytic leukemia is a mature B‑cell malignancy where there is a progressive accumulation of leukemic cells with a distinctive immunophenotype as consequence to defective apoptosis and survival signals derived from the microenvironment. CXC chemokine ligand 13 (CXCL13) chemokines have recently emerged as crucial orchestrators for lymphocyte trafficking and activation. These secreted polypeptides exert their function by binding to specific cell surface receptors and can be divided into two categories: homeostatic and inflammatory. The CXCL13 is an efficacious attractant of naive B‑cells in vitro and has been shown to be produced constitutively by stromal cells in lymphoid follicles of human lymph nodes. The CXCL13‑CXCR5 axis has been previously shown to contribute to the progression of several malignancies and possibly CLL relapse.
OBJECTIVE: The aim of this study to compare the plasma level of CXCL13 in a patient with CLL with healthy normal control and to correlate the plasma level of CXCL13 to beta‑2 microglobulin (β2 M) and other hematological parameters in CLL.
PATIENTS, MATERIALS AND METHODS: This cross‑sectional study was conducted on 50 CLL patients who were newly diagnosed. A total of 30 healthy individuals were included in this study as a control group. Measurement of plasma CXCL13 and beta‑2 microglobulin levels was done by the enzyme-linked immunosorbent assay.
RESULTS: Fifty CLL patients were studied and compared with thirty control group of healthy individuals. The mean level of CXCL13 was 67.48 pg/ml in CLL patients while it was 69.2 pg/ml in control, so it is statistically not significant (P = 0.363). The mean level of β2 M was 50.89 ug/ml in CLL patients while it was 50.59 ug/ml in control, so it is statistically not significant (P = 0.702). The percentage of stage A of CLL patients was 22.44%, stage B was18.36%, and stage C was 10.20%. The percentages of lymphadenopathy, splenomegaly, and hepatomegaly were 66%, 32%, and 16%, respectively. The mean of malignant cell percentage in stage A was 55.18%; in stage B, it was 69.28%; and in stage C, it was 81%, so it is statistically significant (P < 0.001). CXCL13 shows no statistically significant between Cd38+ and CD38− and P value was 0.950.
CONCLUSIONS: There was no correlation in level of CXCL13 between the CLL group and the control group. There was no correlation in level of CXCL13 and β2 M in the CLL group.

Abstract:
BACKGROUNDS: In preterm newborns, thrombocytopenia is one of the most often observed hematologic findings. Most cases of thrombocytopenia are mild to moderate, self‑limiting, and have a short duration; nevertheless, in rare cases, it can result in serious complications including pulmonary hemorrhage that lead to death and morbidity.
OBJECTIVES: The objective of this study was to identify the pattern, risk factors, and outcome of thrombocytopenia in preterm neonates hospitalized in a tertiary‑level neonatal intensive care unit (NICU).
PATIENTS AND METHODS: All sick preterm neonates who developed thrombocytopenia within the first 28 days of life admitted to the NICU were included. A platelet count was performed at presentation time and as needed after that. Thrombocytopenia‑related morbidities (intraventricular hemorrhage, pulmonary hemorrhage, and sepsis), mortality, and risk factors were analyzed concerning severity (mild, moderate, and severe) and age of thrombocytopenia onset (early and late) in preterm neonates.
RESULTS: A total of 100 preterm neonates were admitted to our NICU. Of these, 48% of neonates developed thrombocytopenia. In terms of severity, mild, moderate, and severe thrombocytopenia were present in 62.5%, 37.5%, and 16.7% of newborns, respectively. The prevalent risk factors for late‑onset thrombocytopenia (LOT) were necrotizing enterocolitis (NEC) and late‑onset sepsis; for early‑onset thrombocytopenia, the risk factors were pregnancy‑induced hypertension and early‑onset sepsis. Neonates with sepsis, severe birth asphyxia, and NEC were significantly associated with severe thrombocytopenia (P < 0.001). Thrombocytopenia‑related morbidities and mortality were significantly higher among moderate‑to‑severe thrombocytopenia cases (P < 0.001).
CONCLUSIONS: Sepsis was the most common risk factor associated with severe and LOT. Compared to mild/moderate thrombocytopenia, severe thrombocytopenia required more platelet transfusions, was associated with major bleeding manifestations, and had a higher mortality rate. When caring for premature newborns, these issues need to be taken into account

Abstract:
BACKGROUND: The Philadelphia chromosome serves as the molecular marker for chronic myeloid leukemia (CML) result from fusion oncogene, leading to genetic instability including chromosomal aberrations and common altered genes that regulate cell proliferation and apoptosis. Transforming growth factor‑β (TGF‑β) signaling pathway is an important regulator of cellular functions, such as proliferation, differentiation, migration, and cell survival.
OBJECTIVES: The objective of this research was to investigate the role of TGFs‑β3 as predictive biomarker on disease progression.
MATERIALS AND METHODS: This study includes three groups (50) individuals: newly diagnosed CML patients (male: 28 and female: 22), (50) CML chronic phase (male: 25 and female: 25), and (50) apparently healthy volunteers (male: 30 and female: 20). The National Center of Hematology at Mustansiriyah University admitted the patients. An analysis of each patient was diagnosed using a complete blood count, a bone marrow test, and a BCR‑ABL gene test. ELISA technique was applied to assess the serum level of TGFs‑β3.
RESULTS: the results displayed high significant differences among patients (newly diagnosed) compared to the chronic phase, it was 59.7517 and 39.9167 pg/mL, respectively, and high significant differences among patients (newly diagnosed) compared to control, it was 59.7517 and 36.8861 pg/mL, respectively, as well as the serum level of TGF‑β3, was elevated with some hematological marker.
CONCLUSION: Elevated TGF‑β levels can promote the development of myelofibrosis and some hematologic malignancies by influencing the immune system.